Challenging issues: sleep-wake, augmentation and quality of life

RLS is a common disorder which has an important impact on the health and quality of life of patients, with the main consequences being sleep-related. Special attention needs to be paid to patients with depression. The diagnosis of RLS is based on medical history and clinical examination. The most important laboratory examination is measurement of serum ferritin which should be >40 microg/L. The presence of all four essential diagnostic criteria confirms the RLS diagnosis. To detect secondary forms, a clinical examination and laboratory investigations, especially measuring serum ferritin are required. Augmentation is a problem for some patients, especially those being treated with levodopa. However, augmentation can be controlled by using the lowest possible doses of nonergoline dopamine agonists or by using opioids, gabapentin or anti-epileptics.